Provider Demographics
NPI:1407142185
Name:CORQUAYE, VERNON ATTUQUAYE
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:ATTUQUAYE
Last Name:CORQUAYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:LOCUST
Mailing Address - State:NC
Mailing Address - Zip Code:28097-9723
Mailing Address - Country:US
Mailing Address - Phone:704-888-6655
Mailing Address - Fax:704-888-1027
Practice Address - Street 1:101 MAIN ST E
Practice Address - Street 2:
Practice Address - City:LOCUST
Practice Address - State:NC
Practice Address - Zip Code:28097-9723
Practice Address - Country:US
Practice Address - Phone:704-888-6655
Practice Address - Fax:704-888-1027
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist